Health & Safety Incident Report Form

Health & Safety Incident Report Form

Please complete this form to report any health and safety incidents.

Date of Incident

Time of Incident

Location of Incident

    Incident Report Number

      Description of the Incident

      Summary of Incident

      Detailed Description

      People Involved

      Name

        Role/Position

          Contact Number

            Injury/Exposure

              Injuries or Damages

              Injuries Sustained

                Property Damaged

                  Immediate Actions Taken

                  Action Taken

                    By Whom

                      Witnesses

                      Name

                        Contact Number

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